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Making the Case for Progressive Austerity, and a New Push for Health Care Reform

Mark Trahant

1/23/13

The next four years will be defined by austerity. President Barack Obama, indeed, the country, will jump from one economic crisis to another. And until a consensus emerges about what we should do next, well, every fight will leave both sides unsatisfied.

President Obama made the case for progressive investment by government. He said during his inaugural address: “We understand that outworn programs are inadequate to the needs of our time. So we must harness new ideas and technology to remake our government, revamp our tax code, reform our schools, and empower our citizens with the skills they need to work harder, learn more, reach higher.”

He also promised hard choices ahead, yet, “we reject the belief that America must choose between caring for the generation that built this country and investing in the generation that will build its future.”

But most important he talked about promises. “The commitments we make to each other through Medicare and Medicaid and Social Security, these things do not sap our initiative, they strengthen us. They do not make us a nation of takers; they free us to take the risks that make this country great.”

And so it is with Indian country. The promises made through treaties are not gifts from Washington, but promises that ought to be secure even during an era of austerity. But how to make that so?

That’s a real challenge. Especially when the administration and Congress agree on so little about the era ahead, the hard choices that must be made, or even the promises that have been made.

But if the choices ahead are hard, the division in the country’s politics are even more so.

The most significant step the United States could take to resolve its budget and demographic imbalance is to press forward with health care reform. The Affordable Care Act, or ObamaCare, if you prefer, is just a baby-step. The bottom line is this: The United States spends too much on health care and gets too little in return, our health care costs 17.6 percent of gross domestic product. No other country in the world spends that kind of money. The average among most nations is under 10 percent of the economy and even the second most expensive country, the Netherlands, only spends 12 percent on health care.

We do that one thing – fix health care – and we don’t need to rip apart the federal budget and priorities. We don’t need to strip promises made to American Indians and Alaska Natives by treaties, law or executive orders. We don’t even need to shortchange elders and soon-to-be elders from the promise that was restated in every paycheck (you know, the payroll tax).

But to make that happens we need to keep pressing for next steps in health are reform. We need to move on beyond fighting about what’s barely been started.

The Congressional Budget Office boils this down to two problems: The increasing cost of health care, or medical inflation, hitting us at the same time as the population ages. CBO says: “As aging causes the number of Medicare beneficiaries and elderly Medicaid beneficiaries to rise, higher health care spending per person has a greater impact. Conversely, when health care costs are growing, having more beneficiaries imposes a larger budgetary cost.”

I believe Indian country offers a solution here (as I have written before). Federally-funded, but locally designed and controlled health care centers, such as the Alaska Native Medical Center, show that there is a way to bring the cost of health care down and improve the quality of that care.

At the end of this debate, if there is a resolution, then the U.S. health care system will look more like the Indian health system than the other way around.

Unfortunately, the other way to “balance” the budget is the austerity path we’re on at the present. This basically follows what’s being tried around the world with little success. The problem with cutting budgets repeatedly, and without a strategy, is that there is no way to bring back growth. A country of 315 million people cannot be stagnant.

The practical fights begins today. First Congress will revisit the debt ceiling, and then in the weeks ahead, debate over budgets and the sequester. But absent from those fights are a clear strategy about what success looks like.

Mark Trahant is a writer, speaker and Twitter poet. He lives in Fort Hall, Idaho, and is a member of The Shoshone-Bannock Tribes. Join the discussion about austerity. A new Facebook page has been set up at: https://www.facebook.com/IndianCountryAusterity.

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